Clause 27 - Review of care and support plan or of support plan

Care Bill [Lords] – in a Public Bill Committee am 4:00 pm ar 16 Ionawr 2014.

Danfonwch hysbysiad imi am ddadleuon fel hyn

Photo of Emma Lewell-Buck Emma Lewell-Buck Llafur, South Shields 4:00, 16 Ionawr 2014

I beg to move amendment 114, in clause 27, page 24, line 4, leave out ‘keep under review generally’ and insert ‘review regularly’.

Photo of Hugh Bayley Hugh Bayley NATO Parliamentary Assembly UK Delegation, NATO Parliamentary Assembly (President)

With this it will be convenient to discuss amendment 115, in clause 27, page 25, line 33, at end add—

‘(5A) The Secretary of State after consultation must establish by regulation appropriate arrangements and timetable for the regular review of care and support plans and of support plans by local authorities provided for in subsection (a).’.

Photo of Emma Lewell-Buck Emma Lewell-Buck Llafur, South Shields

These amendments would perform a similar function to amendment 113, but would apply to the review of care plans rather than assessment. In my experience, it is the review stage at which delays are most common and local authorities fall the most short of their duties. The amendments would require local authorities to conduct regular reviews of service users’ care and support plans and establish a timetable for that through regulations.

In my constituency, care plans are supposed to be reviewed every 12 months, but that does not always happen. Just a few days ago, I spoke to a constituent, Mr Bennetts. He is registered blind and his sight loss is increasing, but his most recent review was more than three years ago. As with assessments, I understand that time pressures on care workers mean that routine assessments are often put on the back burner in the face of more urgent cases. However, that does not change the fact that, without regular assessment, checks show that many people’s conditions are allowed to deteriorate. Stronger terms need to be put on local authorities to ensure that such checks are carried out.

Care plan reviews are particularly important for people with progressive or fluctuating conditions. For them, even a few weeks can make a huge difference. A person with a progressive condition whose needs are not assessed for many years may find themselves with support that is completely inadequate for their developing condition.

Regular reviews also provide a built-in check on the care system, which can improve safeguarding. Regular contact with service users enables inadequate care to be  identified quickly. I was involved with a care home in my constituency where, due to a lack of scrutiny by a number of agencies, criminal negligence went on unchecked. That had heartbreaking consequences. I do not ever want to experience that again and nor do I want anyone else to have to.

Like amendment 113, the amendments deliberately do not specify a time scale, as that is best left open to consultation. However, even the current target used in most areas of an annual review is too long, given the speed with which conditions can change and the vulnerability of some clients. Adult social care workers are fed up that their profession never receives the same rigour and attention as children’s care, in which review meetings can take place as regularly as monthly if a local authority has concerns about a case. Local authorities strictly keep to children’s social care time scales because of the emphasis placed on child protection and the public scrutiny. There is no such urgency for adults.

I am sure that the Minister agrees that an 85-year-old with dementia deserves the same protection as a vulnerable child and that, therefore, the priorities need to be rebalanced. I fancy, however, that the Minister’s response will be the same as for my previous amendment. When responding, I would like him to think seriously and carefully about the message his Government is sending to service users and local authorities by not prescribing any time scales in legislation.

Photo of Meg Munn Meg Munn Llafur, Sheffield, Heeley

I want to make a brief point in addition to those made by my hon. Friend. It is important to review the care that service users receive, not just because their needs change in a negative way, but because they could improve. Some of the most successful cases that I dealt with in practice were where, by providing a significant amount of care at the point when a person was discharged from hospital—thus enabling them to be discharged—a review quickly after that enabled care to be reduced, often much more quickly than either the service user or the social worker expected, thus releasing the budget to be used for other people.

Often, particularly with elderly people, the issue is a lack of confidence after a period in hospital. Returning home is a bit of a lottery; no one knows or can judge properly how that person is going to cope. My experience was that, by putting someone in who slept there, perhaps for a week or two, that elderly person could be enabled to return home to regain their confidence. There could be a proper assessment of just how able they were to cope at home. Subsequently, their care needs were often reduced to the level of home care that they had before their admission to hospital.

Not to proceed in that way could lead to a person entering residential care, with their lack of confidence compounded, the costs escalating, and the person never going home. Looking at early reviews and ensuring that the needs of people, both when they deteriorate and when they improve, are properly addressed and supported by changing services are fundamental to a much more efficient service.

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

On the hon. Lady’s final point, I agree that the whole objective should be to help a person improve their mobility and well-being; that is at the heart of the Bill. We all need to be focused on improving well-being.

One of the things that I feel strongly about is the need to improve how commissioning works by providing incentives to providers to improve well-being. We have amended the Bill through clause 5(4) to require local authorities to focus on well-being when they are commissioning services.

We know that if the right things are done, we can often reduce someone’s dependency. There is a role for the voluntary sector, friends and neighbours to help as well, tackling the awful consequences of loneliness. That can have a massive impact on reducing loneliness. Therefore I am very much with the hon. Lady, and I share the view that a follow-up assessment makes absolute sense if we can identify reduced need.

The points of the hon. Member for South Shields were, on the whole, well made. Right at the end, she introduced a sour note, which I thought was misplaced. The whole tone of our discussions has been about valuable reforms, which I think most people are behind. We are trying to achieve something that has been widely supported. The sense that the Bill sends a message about what this Government think of people introduces an unfortunate tone, which has been missing from the discussion until now. I gently chide her in that regard.

The local case described by the hon. Lady, about someone who has been waiting three years for a review, is absolutely shocking. I hope that she is taking her own local authority to task for that complete failure of care and support for that individual, who is clearly a vulnerable person. Failures can occur all over the system, and we should be indiscriminate in being unwilling to accept them where they occur.

Amendment 114 would require care plans to be reviewed regularly. Taken in conjunction with the related amendment 115, which would provide for regulations to specify a time frame for the regular review of care plans, the effect would be to establish a review period that local authorities must adhere to. Clause 27, which deals with the review of care plans, creates a general duty to keep plans under review and a specific duty to review a care plan whenever the adult concerned requests it. The clause introduces a right to a review if a reasonable request for one has been made, which should help in cases such as that of the hon. Lady’s constituent who has been requesting a review and not making any progress.

The clause also requires the local authority to revise the care plan and carry out fresh assessments whenever it believes that an individual’s needs or circumstances have changed. We believe that to be a more pragmatic way of fitting reviews around people’s lives. It supports our policy of personalised care, because it bases the decision to review on an individual’s needs, not on an arbitrary time scale. A regular review would imply only that the frequency of a review was consistent over time; it would not necessarily mean that the frequency was right or that the review took place at the most appropriate time for an individual. Our proposal to keep the plan “under review generally” would ensure that it was monitored constantly, and steps could be taken to change it as required.

Local authorities must act reasonably in the discharge of their duties, including those in relation to care and support planning and reviews. It would not be reasonable to delay or extend that process, as in the case of the hon. Lady’s constituent, beyond what is appropriate in an individual case. We will set out in guidance best practice  for conducting care and support plans and reviews, and we will work with social care partners to include indicative time scales for care plans. I hope that that might help the hon. Lady. For the reasons that I have given, we intend to refrain from specifying and prescribing time scales. I hope that on that basis, she will agree to withdraw the amendment.

Photo of Emma Lewell-Buck Emma Lewell-Buck Llafur, South Shields

I believe that the word “generally” is too vague, but I will not divide the Committee on the issue. I am comforted by the Minister’s response, but not entirely convinced. I would like to think about the matter outside the Committee and I may return to it at a later date. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 27 ordered to stand part of the Bill.

Clauses 28 to 32 ordered to stand part of the Bill.